The long term objective of this project -- provision of independent mobility to a population who currently has none (individuals who are candidates for power mobility but have severe motor impairments of the upper quadrants that prevent them from operating commercial wheelchair controls) -- is consistent with the mission of NICHD - to provide rehabilitation technology to increase mobility to allow those with physical disabilities to be active members of their communities. The purpose of the proposed project is to establish proof of concept of an orthotic wheelchair controller (Self-referenced Personal Orthotic Omni-purpose Control Interface abbreviated as SPOOCI)) that will allow functional mobility for this population. The rationale for developing SPOOCI is to: (1) Move the point of access from the wheelchair to the user's body to reduce the effect of extraneous movements, (2) Provide a "wearable" interface, (3) Simplify the motor task by sensing isometric force rather than movement, and (4) Eliminate the need to maintain a position at or near midline. Our innovative concept is distinguished by referencing the control sensor not to the wheelchair frame but mounting it instead on the adjacent proximal body segment via a custom-formed orthosis. Aim 1 objectively determines whether and how well individuals who with severe upper quadrant neuromotor impairment who cannot drive a power wheelchair with a traditional joystick can do so using a SPOOCI. Aim 2 evaluates the level of functional wheelchair driving competence achieved through the use of SPOOCI using the standardized Powered Mobility Program. Aim 3 incorporates qualitative interview methods to examine user and caregiver experiences, attitudes, and beliefs regarding the use of SPOOCI. This project will comprise a development and experimental phase. The developmental phase will incorporate the standard sequence of conceptual and detail design, prototyping, bench evaluation, and repeated revision, leading to a beta prototype of a new PW control system which is safe and suitable for testing by the intended user population. During the experimental phase, pilot data will be collected to address aims one through three above. A graphic profile will be created for each of the five participants that will include weekly performance outcomes (speed, accuracy, and Fitts constant) data and pre and post functional driving scores. Performance outcome measures will be correlated with functional driving competence scores to determine at what point performance measures translate to funtion. Qualitative methods will be used to examine user and caregiver experiences, attitudes, and beliefs. PUBLIC HEALTH RELEVANCE: Research suggests mobility, access to the community, and social integration enhance quality of life. In fact, social participation has been found to be a more important predictor of quality of life than physical functioning or extent of injury. This project seeks to provide independent mobility to those who presently are dependent upon others, so that they may participate in society and meet their daily needs.